Heroes of Healthcare
Heroes of Healthcare

Episode · 10 months ago

Pharmacology, COVID & the Future of Medical Treatment

ABOUT THIS EPISODE

Medication regimens can at times be extremely complex and scary for patients. It can be helpful to have a guide — someone who can explain what they are taking, why they are taking it, and what side effects might occur. That’s where the pharmacologist comes in to save the day.

In this episode, Dr. Becky Bean, Senior Vice President and Chief Pharmacy Officer at Novant Health, explains the important role pharmacologists play in a patient’s treatment.

Topics covered:

  • The deeper dives of a doctorate pharmacology program
  • The pharmacist’s role in COVID treatment
  • Precision medicine, digital care technology, and the future of medical treatment
  • Health equity

To hear this interview and more like it, subscribe to Heroes of Healthcare on Apple Podcasts, Spotify, or wherever you listen to podcasts.

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Just very rewarding to help people feel a little bit more comfortable about taking medications and being successful and actually improving their health versus the risk that sometimes can come along with medications. You're listening to heroes of healthcare, the podcast that highlights bold, selfless professionals in the healthcare industry focused on transforming lives in their communities. Let's get into the show. Welcome to the heroes of healthcare podcast. I'm your host, Ted Wayne. I'm excited to be back and want to give a big shout out to my cohost, Olivia d' Angelo, and the outstanding interview she had last episode with Dr Priest of Navan. No surprise, we had record breaking down loads and we love having Olivia as part of the show. Today I'm excited to discuss a topic that we haven't hit since our first episode with my father, and that's the role that the pharmacist plays in the healthcare system. Joining me today is another of the outstanding team of clinicians from Navan Health System, Dr Becky Bean. Dr Being currently serves as a senior vice president and chief pharmacy executive at Navan health. In this role, she's responsible for the development and implementation of Nevan Health's strategy for the system wide pharmacy services, consistent with the mission to improve health of the community one person at a time. Becky received her BS and pharmacy and pharmacy doctorate from the University of North Carolina Chapel Hill of being joined navant health in two thousand and seven as a clinical pharmacist and transition into leadership in two thousand and thirteen. She moved into the role as a senior director of medication management in two thousand and seventeen, and then this role, Dr Bean has led the Implementation and collaborative practices for pharmacists across the Navat Health Medical Group. She has created a structure to support managing the complex medication needs of the patients across the continuum of care. So it's without further ado I'd like to welcome to the show Dr Bean. Welcome to the heroes of Healthcare Podcast, Dr Bean, thanks for joining us. Yeah, glad to beat her. Thank you so much, Ted. Yeah, we're as always, always excited every time we have a new guests. So I think I hear myself saying all the time I'm so excited, but I always am so it's legit, but really excited to have you here. Want to talk a little bit more about pharmacology, your area of expertise. Again, a little different. The opening episode was with my dad and he was an oldtime pharmacist, so we haven't talked about this side of the healthcare world in a while. So it's great to have you here and to talk all things and how pharmacology plays its role in the healthcare system, and especially during the whole years of covid. So before we jump into some of that, hope you could just spend some time and tell our listeners a little bit about yourself and how you got into this crazy world of healthcare, and we'll just jump right in. Yeah, absolutely. Well, first of all, thank you. It's really exciting to have an opportunity to share sort of the pharmacist story, the Pharmacy Journey, the things that we did a contribute to patient care. So really privileged to have the opportunity. For me making a decision around what I wanted to do with my life and I spent some time thinking about what am I good at, you know, what are my natural skills, but also, you know, what means something to me, what ties back to my purpose, you know, where can I use my heart in the work that I'm doing? And so I landed on I felt like math and science was my wheelhouse, and so I knew I wanted to do something related to math and science, and I actually had a friend growing up in high school who was a few years older than me, who went to pharmacy school, and so that's what sort of triggered pharmacy in my mind is potentially being an option, and so just started doing some investigation around what that means, what the opportunities are, and felt like it was something that I could be good at and something that I could actually make a living doing. So that was the reason for going into it, but I'll tell you, you know, it was it was a tough journey. There were times in my college career I can remember taking organic chemistry and thinking maybe this is it for me, but I'm really glad that I stuck with it because it's been such a rewarding career. It's very rewarding to help people feel a little bit more comfortable about taking medications and being successful and actually improving their health versus the risk that sometimes can come along with medications. All of those connection points and having an opportunity to be a participant in helping somebody a chief better health is such a privilege. So I'm glad that I stuck with it. Yeah, it's you know, it's you know, you said, you said the word purpose, and I just more and more, as I guess I get older, I realize that it's really key, it's really critical. It's just finding that thing that you feel gives you the purpose. You know, without purpose, we we tend to feel a little bit lost. What made you decide to go? You obviously the two pass within pharmacology. Probably typically is clinical. I guess you have research, clinical, institutional and then retail. What made you decide to get more into I guess what I is at my saying that right you more in the institutional and too, in the healthcare, since my health system somewhere in the health system industry. You know,...

...when I was coming out of Pharmacy School, Pascius was one thousand nine hundred and ninety six, so it's been a minute built the time, but at the time you just didn't have as many options. So you had retail pharmacy, you had a hospital and you had industry, and you know, it took me a little bit to figure out where my niche was in the pharmacy world and I've actually been in a lot of those different areas. So I actually started in retail pharmacy, like many pharmacists do, and had that opportunity to work in a community pharmacy and just really help patients gain access to medications and do patient counseling in those sorts of things, and it was a it was a tough job at the time. I mean it was long hours, you know, twelve hour days, weekends, evenings, and so it was just it was a tough job and I really enjoyed it. I developed a lot of great relationships with my patients. Even sent Christmas cards out to all the patients and loved it. But at some point just felt like I wanted a little bit more work life balance and I wanted to have more of a, you know, Monday through Friday type of role. And say ended up moving out of retail pharmacy and spent some time working in a hospital. I moved to Raleigh where I grew up, worked in hospital for a while and really loved that and then, like many folks do, relationships can sometimes draw you away from a location. So and move back to Charlotte to get married and spent some time working in long term care where I really had an opportunity to flex some of those clinical skills that I that I learned in pharmacy school and broadened my view around what options exist. So there's not just retail, hospital and industry, there's long term care, there's managed care, there's working in clinics with physicians and Helping Tailor Medication regiments to a particular patients needs. Its lots more opportunities. But I ended up working in long term care where I would literally, you know, had twelve different facilities that I would go every month and I would do chart reviews and make sure that whatever medication we were using for a patient connected back to a reason like an indication, and make sure that we were tracking side effects and reducing risker falls and things that can sometimes be more risky for older patients and Rove that work. Love that work, I mean I could see the difference that I was making every day in involved working with nurses and involve working with physicians, a lot more patient contact sort of in the later stages of life, and it actually inspired me so much I went back to school to pursue my doctrines. That's when I went back and got my doctorate because I felt like there was more I could do if I had just a little bit more clinical knowledge in the application with that clinical knowledge and spend a lot of time there. But again, yea, it took me a little bit to find my niche and where I wanted to go as intervening a little bit earlier. So it was great to intervene and folks that were in long term care and we're in the later season of life, but wanted to start moving that a little bit earlier in the life stage, and so an opportunity opened up where I am today, which is now about health, to focus on transitions of care and help patients navigate from being in the hospital to being back home to be more successful, because what we were findings that people would come back into the emergency room or back into the hospital because of some kind of medication related events. So our pharmacists would call patients after discharge and literally just walk through you hear all the medications that you're taking. This is what I want you to stop, this is what you're going to start taking. Make sure they actually got the medication and then walk through with them the why. Why are they taking it? What do I need to watch out for? What would mean I need to call my physician right away? What are things that might just get a little bit better over time? And it was very rewarding to spend and we were spending forty five minutes, you know, sometimes an hour with patients, just helping them walk through the complexity. If you've ever known or been in the hospital, it can be complex. You can have a lot of changes that occur in the medication regiment. is so that that time we took interacting with patients and helping them understand the why and make sure they were on the right path to be successful with whatever changes were made resulted and pretty significant reductions and readmissions. So we have thirty day readmissions and Sixty Day readmissions dropped pretty significantly and I say to the tune of about seventy percent. So just that one intervention that wasn't rocket science, it was just somebody who had knowledge and expertise around, you know, how to take medications, really translated into some great success. And so that's when I knew I had kind of found my Adnitch, you know where I wanted to be the work that I wanted to do. So that was a very long answer, but I guess my my key messages. It took me some time to figure out what my purpose was and what I really wanted to contribute and how I wanted to help patients navigate what can be pretty complex and pretty scary and help them be set up to be successful. Right. Yes, it did. You ever was at an aspirate? I mean you most careers and a lot of times they evolved in the path that we think we're going to end on. Is Not and we never think we are. I know for myself where I am today and where I thought I would be as nowhere near the same plan. But that's okay, and need to think if you ever is that. Was it an aspirate? You...

...know, but I'm also talked to people and they said, aspirationally, this is where I wanted to be. Was this? Do you ever envisioned? You said, I want to be able to be part of a big healthcare system and be running the whole thing. No idea. I mean I always say if my the title to my biography would be Farendipity, like things just happen like I think I'm luck into things. Sometimes it's timing, it's right seeing opportunity, it's being in the right place at the right time. I never anticipated leadership would be my path. I know it was really more about providing patient care and doing what I needed to do to provide the best care that I could. So, whether that's clinical knowledge, whether that's learning how to talk to people and communicate more effectively, I focus a lot of my energy there. But when I was here, probably five years into my journey here at about health, somebody saw in me some leadership potential that I didn't see in myself, and so they encouraged me to go into a manager role, apply for a manager role and start leading the team rather than being a part of the team. And so had the opportunity to step into leadership and it's a it's a difficult transition sometimes to move away from what you love, which is the patient care, and being more in a leader position. But what I found every time is I had the opportunity to really paint broader brushstrokes in a leader position where I could set many more people up to provide the same level of care, to be there for patients, where and when they need it. So being in a leader position just allowed me to really design more vision and strategy for how we could do this on a broader scale. So that's what that's what drives me now. So it's not necessarily the patient care. The one one that I might do it's sending my team up to be there for our consumers when and where they need it. Yeah, well, you're having a broader impact. You're still having an impact on patient care. You're just now actually able to do it and in a more broader sense acting. The questions I had is it's you. So when you come out of pharmacy school and you'd pass your boards, you're a license pharmacist. What different things? And it's funny I saw ask my dad this, but he because he's his master's in pharmacology. But what different things did they work on in you to get to your doctorate? Is it a broad case of everything from more depth in the chemistry part of it and all the way through the application? Just a little let's spend a few minutes of various great question. So the difference, so when I graduated, and there's been a lot of evolution and how we train pharmacists and how we educate pharmacists. But when I came out it was a bachelor B S Program of Bachelor's in science, and in North Carolina and many states they actually change the requirements to get licensed to where now all pharmacists come out with a farm dy or a doctorate in pharmacy. But at the time that I was coming through there was different. There were two tiers. There was bachelor's and then people could go on to pursue the Pharm D and I would say the difference between the curriculum and the Bachelor's program and the Pharm d program was probably more of a deep dive in to some areas of pharmacy that you don't get in the Bachelor's program and so one of those deep dives would have been into more pharmaco kinetics and so how do how to medications function in the body and how are they eliminated? What does that look like and how can that change depending on patient characteristics, whether it's, you know, the kidney function or their liver functions? A lot more deep dives into that, a lot more deep dives into how we prescribe and use medications for certain disease state. Since it was a lot more clinical in nature. And then the second piece that's different as a part of a doctorate program as we spent a whole year in rotations, so in the field functioning as a pharmacist, you know, in the field with physicians and nurses and training around how to function as a care team to deliver better care for patients, and so it was a much more intensive program compared to the Bachelor's program from an experiential perspective, I found so much value. People Laugh will ask me sometimes do you wish you had just gone through you got your bachelor's and doctorate at the same time, because I had about ten years between getting bachelor's and getting the doctorate. I mean it would have been easier to do it all at once and as I went back to school while I was working full time, but I felt like as I was learning and getting these deep dives into some of those areas, I was applying it real time. Well, I'm learned that I was very easily seeing the application of the things that I was learning and how that helps me be a better pharmacist, and so that was rewarding. While it was tough to work full time and be in school, pursuing a doctor at that like I got a lot more out of it than maybe I would have had I done it immediately after completing the Bachelor Program Yeah, I think it, since she said, so key. You know, they talked about, you know, generational the the younger generation in terms of how they learn, and they talked about since, since Google, the younger generation does not need the older generation for information. So when I was growing up, either it was my parents or are an encyclopedia. That was where I got most of my information. But now we google everything and we google it is we're walking down the street. But what's been interesting, and and I love what you talked about, that what they say with the younger...

...generation is what they're what they're struggling with this application. So they can go to Google and they can see how things are done, but they don't always understand what is the application of this in life and how do I use it and all that, and I think that's so, so key that in the doctor program they're saying, okay, here's the theory stuff we're giving you. Okay, now let's go apply it and see how it actually works and where does the theory fall short and doesn't really hold and where is it? Like wow, this is the area really need to do because, as we know, anytime we go and do it and experience it, it's it's often different than what we perceived in our own mind or we're told that it was. Absolutely it's not like memorizing content because I need to take an exam and there they answer to the questions like I'm applying it every time I'm interacting with the patients. It's just a different experience when you have that application at the same time that you're actually learning and learning the curriculum. Yeah, that's great. So let's jump in a little bit. Well, let's back up in time. I tend to do this, but I don't you know, and I love back and at the time. Yeah, a couple of in time and then let's look forward, because I like both of those things. So, you know, I said to you before we got jumped on the call, I keep wanting to to get away from covid a little bit with the show, but we're rising in cases again with the Delta variant, so I guess it's still hot topic. But let's back up and talk about navant and you know, I guess now almost eighteen months ago, but warry and March two thousand and twenty. I guess I'm saying that right. If and things breaking out, and one of the things I read about an article for Navant was you guys did a great job of anticipating the refrigeration needs and some of those sorts of things in expectation for the vaccine. But tell me the role that the pharmacy and your team played as Covid was breaking out and how does farm, how does the pharmacy team fit into this whole healthcare delivery? Yeah, absolutely. You know, it's funny. I'm going to back up even further than ultralow temperature freezers. Leek. I can remember the day that my leader, Eric Sciagalu, called me and said Hey, covid nineteen, there's there's a there's a virus at spreading and China wive on it. Is the pharmacy supply chain stable and what do we need to watch out for with with getting drugs in the door and so that? I don't think at time I could have known what this was going to become, but it ended up being very much a focus for us from a pharmacy perspective. It wasn't just about, you know, how we treat patients in the clinical algorithm and what does the evidence say and what are the research trials that we can engage and it was like, basics, we need to get drugs in the door and make sure we have enough drugs to care for our patients. And so we have a lot of conversation around, you know, what things are. We worried about what's produced in China. What would we see those out and what we are and what are we even going to need right? What are we going to need? Yes, I mean even those early conversations were so challenging because it was hard for me to even imagine, you know, a day where we wouldn't be able to bring medications in. And so we did a lot of just thoughtful planning around that, making sure that we had if there were certain medications that only one, one option and we can't you know, there's no alternative, we would try to order up on some of those things in a feasible way, but we really had a good plan for how we make sure we have enough drugs on hand to care for our patients. And then, as we learned more and more about what that meant, from the pandemic perspective, what medications we were using for these patients. We were able to create some analytics and like a real time way to predict how many medications we would need on hand based on our bed count, based on how many in patients we had with covid and so we could get really precise around inventory management. That, I think, helped set us up to be really successful. We did not have any challenges with getting drugs in the door that we needed. So that was a real, real success story and one of the benefits of working in a large system. We were able to move drugs around based on where it was needed. To think about the time when we stopped elective surgeries. Well, we didn't need to store drugs in those units anymore, so let's move those drugs around to where it where it's needed. So if it's something to for somebody who's on a ventilator, then let's move it to where we need those medications around. So being able to be flexible and nimble like that really really helped us. That's one getting drugs in the door. The second piece that I think was really just a trend, like a powerful message just around teams and how we function as teams and we leverage the expertise from the physician to the nurse to the pharmacist to provide better care. We had a really good model of scanning the literature, I mean sometimes hourly. What's working for these patients? What are people using? What does the research tell us? And so we leveraged our clinical pharmacists with with expertise and infectious disease to really help us scan that literature so as we were needing to make changes to our treatment algorithm, we could very quickly make those changes. And so that was a beautiful partnership between Pharmacist, critical care physicians, Emergency Care Physicians and Turnist, where we were served this multi disciplinary group that was constantly evaluating how we're treating patients, what the outcomes were telling us, what the data...

...was telling us and, more importantly, how we may need to tweet that based on the information that comes and so that was a wonderful partnership. Yeah, I have I'm started army that throw, but yeah, I want to just point that. Not Thinking about that, but yeah, what you know, where's the team? Right? So, if I end and if I understood so, as the clinicians the doctors are in treating and doing your team is monitoring, which, again, we've heard throughout the if there's one of the many consistent themes that we've heard through all of our guests is that in those early days we didn't know it didn't it was. You know how to treat it, we didn't know right creat it with. We didn't know what was working. As you said, we're looking at what's the literature saying what are our colleagues and different cities, different locations and saying so it's so. The pharmacy team was the one kind of monitoring, looking at the weather channel right to say this is what seems to be happening and here's what's going. So that allowed the clinicians to remain focused a just as you guys could provide data, but they didn't have to go spend their time trying to find that information. You guys are feeding it to them. That practly, yeah, helping to support because you can imagine, there was so much information coming out. Yeah, I like so rapidly. I mean that I don't think we've ever seen that pace of studies and data and trials and things being published like we did in the covid days and you know, we needed somebody, we needed people to be scanning that literature and what's what's information that's going to influence how we care for these patients. And I don't remember a time in my career where, you know, in Seattle they were experiencing some of the first cases and New York and there was just collaboration across the country with folks that were providing care to learn, you know, what was working well and how can we be more successful. So that was wonderful partnership and collaboration that I think helped us along the way for sure. Yeah, well, and I'm sure you know you guys have much access to much more scientific and clinical data. But even just I'm was there influence, because I remember when there was a quick for a hot minute there everybody, I think, and I kind of cynically say I think. I think it was proctor and gamble. I think they might. I said they put it out, but til it all sold out because everybody said he can't take Gad bill with this. It makes it worse, and so everybody. So the shelves cleared out of time and all and that sort of stuff. Will you guys being at all influenced by what some of the you know, disinformation or misinformation that was going on maybe over social media or stuff. How do your pharmacists do that? They block that out and just only go to clinical resources, or does that influence sometimes some of the conversation? So I would say that the pharmacists know where to go to get reliable information. So they have specific sources that are vetted, that you know, you know as a trust. It soverse and that's where you go to get information on trials. Because you're right, there's so much more information out there then when we were growing up and it was a cycle is that you were going to. So it's just a totally different world. So knowing where this trusted site, you know, the trusted groups that if they endorse this and that's the right thing. So knowing that information is one thing. I do think it's a challenge from a consumer perspective. You know, and I'll bring up the example of Highdroxy chlor Q, when I remember when that we were using that initially and people just started going out and hoard let even like stories of physicians writing themselves prescriptions and going out and getting highdraxic chloric when to protect themselves when there's really no evidence to support that it would work in that setting. Is So the Board of Pharmacy in North Carolina actually had to put out some language and some regulation around high draxy chloric Quinta a voide, supplies just completely getting exhausted and then patients who take it for other conditions were worried they weren't going to be able to get their hydroxychloric win and so things like that really created some supply issues. Because of information that may go out, people apply that information in a way that's maybe not not ideal, and then the next thing you know you're creating shortage shortages and creating issues that that didn't need to be there. So the title and I was a great example. Hydroxychloric whe's a great example of one of those drugs we had to really closely monitor. The other example a Zithromysin, was an antibotic that there was some initially we were trying that for some of these patients and so there were runs on that that were happening in the patient setting, and so we just had to be really cautious around what supply look like broader than just within our system. But in the market place, so that we could make sure that we had the drugs we needed to care for the patients. Yeah, but you will, but you have to have the discipline right not to not to be influenced by the things that we tend to be influenced, because I'm sure any but into your team might have been sitting on their drive into work or just listening to having their morning coffee and hearing the things about tyle rol, about things, about the other things and saying, well, maybe, maybe we should be looking at that. So right, but also have an open like your mind open enough. Okay, well, let's let's investigate when these are let's discussed that. Yeah, let's at least. Well, all be Craz let's talk about it. Right, exactly, exactly. The...

...other thing. I think I mentioned research, but that I mean early on. You know, we were hearing some some conversation around Rendessevie and the fact that maybe all to be effective and help and at the time, you know, it wasn't available, and so we our research program was really an overdrive trying to find trials that we wanted to participate in that would give us maybe some access to some of these drugs we may not otherwise get. So that was also critical to our success, just making sure that we had a infrastructure in place to be able to go after the right studies that made sense for our population, that we had people that could help do the work. But it was a nice strategy and really helped us grow and build our research program which continues and continues to grow to this day. So that was a nice partnership between a lot of different stakeholders in the organization. So the question that kind of possimated so and and I want to go but I want to continue to go back, but let's go forward again for a minute with my question. Will spend the time. But uh, if you think about it today, if it's so, if a patient comes in today they're positive for covid what is the standard care? Have they established a standard care which is okay, now you need to give them this, I call it the cocktail, meaning a couple of different things that we treat them with pretty regularly. has there become a standard out in the across not just in navant but in across the country, where this is the this is the standard of care for a covid positive patient? Yeah, yeah, I would say there's some there's some standards, just based on what we now know today, around how to care for patients with covid nineteen, and it typically depends on the severity, the severity of the disease where than they require oxygen, what that looks like for that patient and that dictates what treatment regimen somebody may receive in the hospital right proxisting conditions. I'm sure too that. So there's a whole algorithm that the the physician and the care team can walk through based on how somebody's presenting, and that will point them in the right direction with what medication to use for that particular patient. So we do have some options. I would say, you know, I wish we had a silver bullet that somebody comes in with covid nineteen and this is the drug that we give them and that cures them. But we just we haven't gotten there yet. I mean really everything that we have in our arsenal is more around reducing progression into more severe disease or trying to keep people to the less severe side of things and keep people from having to be in the hospital. But nothing seems to be that silver bullet that's curing covid nineteen. For my perspective, the best way to treat covid nineteen is to prevent it through vaccine. Our vaccines have been very effective at preventing covid nineteen, much, much more effective than any drug that we could try once somebody has covid nineteen. So so far that's our best strategy and really some of the messaging is round where it's now preventable disease. If we are getting folks vaccinated, we can prevent books from getting covid nineteen and then the ones that do test positive, that the severity of the case is so diminished that it's not leading to hospitalization and death like it once was. So great, great news to have a vaccine. Yeah, okay. So, yeah, because when my as I mentioned again in the show, when my father did get it and get sick, you know, fortunately within two days he was back out. You know, I've got, you've had it for about ten days. He was getting, you know, not getting better. We put them in and in ten days he was out and be you know, they treated him with a series of different things, you know, both to prevent and to strengthen, steroids, some of those sorts of things. So, yeah, so you're not seeing any one specific. We you know, we go to Remdempsivie, we go to a steroid, we go to this. It's really it's there's a handful of things all applied based on a case by case basis. Yeah, yeah, and it depends on severity and oxy to requirements, that sort of thing, for sure. Okay, so let's go back again. We'll go backwards again. Let's go so you so you remember? You're talking about how Dr Eskiaglu, who we love and have had on the show, so we're fans too, but he's telling you about this is coming out and you guys are starting to do the research and feeding the team is there as they're dealing with the front lines. Yep, even like made a little map on a little piece of paper. Okay, this is where Uhana is, this is where the trains. You know, all the trains go in and out of China. I mean it was just like eye opening how much was coming out of China and the supply chain issues that we were likely to experience as a result of the pandemic. So that that was really fascinating. But I also you mentioned ultramow temperature freezers and this is also a great example of something comes out in a press release from fiser around potential storage requirements for their product, their vaccine candidate, and it sets off a chain of events that make the supply of the this freezers very short, and so we had to act really, really quickly. So that came out. I want to say it was I can't remember what month it was. It was in two thousand and twenty, maybe April of two thousand and twenty, when that information can a must. I can't remember what month it was, toad, but when the information came out, probablable or it's all about it later we're like, okay, let's secure at least, you know,...

...some ultralo temperature freezer stories so that we can be prepared when the vaccine comes. And it was interesting because, you know, it felt like we were investing in something, but we didn't know exactly what was going to be coming out. We didn't know. We thought it was going to require ultra low temperature freezer storage, which it did. So we were glad we had the capacity to store the vaccine when the time came, but we didn't know how many, you know, doses per bile, what that was going to look like, what kind of capacity we would need it in our freezer to be able to store the vaccine. But we were very proactive and making sure. Okay, it's worth whatever the investment was to make sure that we have these freezers on site and it was going to take four months to get those freezers in, so we had to act pretty quickly to make sure that we would be able to manage when the time came when we had vaccines coming in our door and it became such a topic of conversation. The media was interested in the ultralow temperature freezers for everybody was interested in that. But we did have to invest a little bit just to make sure that we would be able to have the number of vaccines that we needed. And the other thing we couldn't predict, as when, you know, when we were going to actually have vaccine coming in our door, how much of it would we have? So we had to take some well calculated bets around what we would need to be successful come December when the vaccines actually arrived. Sure, because you could have made the purchases of these things. I'm sure they're not cheap and you know, they could have been sitting in a warehouse somewhere and they said, oh no, you won't need those. You they're find it room temperature right, and you said they are okay. What do we do with these things? And, like a lot of things with the pandemic, we had to make decisions with just a little bit of information. Yeah, and hope, but those decisions were the right ones and it's fortunately set us up to be very successful. I mean very glad that we've got what we've got. And you know, it's just ironic to me that as time has gone on, we get more and more information around storage and how long things are good in the refrigerator. So it's less of an issue now as it was then, but at the time that was number one priority. We want to be a leader and getting our community immunized and this is what we're willing to do to make sure that that happens. Yeah, so when you look back now, hindsight was was the your predictions on capacity about right? Did you guys have? Did you have enough storage to take in what you needed? Yeah, only what was available. I'm sure at some points you might have wanted more, and it wasn't even available for several months. I mean the demand was so high to for people that wanted to get vaccine in. The supply was very limited. I mean was trickling in at a snail's pace, so we were administering everything that was coming in the door. So we didn't really need a whole lot of storage initially, but we're starting to see that obviously flip where we've got more supply and less demand, and so we're prepared to store it and I would say our predictions were pretty spot on. Yeah, I think the Multitas stiles and the extra doses in the vials and all of that met that. We have more storage than we initially thought, which is fine because I do think this technology is technology of the future. So they're going to be more medications and things that come out that require ultralow temperature freezer storage, and so now we're set up to be able to accommodate that. So it certainly was a good investment, not just for vaccine but for what we're expecting from a drug pipeline perspective. Great, so let's talk a little bit about that, about the technology. Yes, explain a little bit more about you, what you mean by that and why this is different. Why do you think this will be more. This is the beginning, not not a one time sort of a thing. But let's talk at the technology differences in the especially the fiser and Maderna models. Yeah, so the work on the Mrna virus work and sort of that science behind that vaccine is not new. I think there's been a lot of research on it for a very long time, not just for vaccines but also for treatments for cancer and things like that. So the MRNA technology and science is part of the future and so we continue to look at drug targets, vaccine targets that may help us treat conditions that we've not been able to treat effectively in the past, and so that's why I say I think you think they're going to be continue to be products that come out that probably need that type of storage, that ultralow temperature freezer storage, especially for longer periods of time. So the sets us up to be able to do it and it's part of what's so exciting about the MRNA technology is that it's not just this vaccine. I think their future vaccines that are in the pipeline that that we may benefit from. There's cancer treatments in the pipeline that we may benefit from. So it's exciting to see US finally to a spot where we're at least we've got a covid nineteen vaccine that's been super effective and who knows what's next, so excited to see what that might look like. So let's Bret and let's just spend a couple more minutes because I just think it's so important as we are continuing to encourage vaccination. I don't think. I don't think it's any surprise for those of us who are pro vaccine who say the variant, the Delta variant that's now spiking in the US again, is affecting the last number I heard was ninety seven percent of the patients are unvaccinated. So message to the people who are not who might be afraid of it, that it's clearly those of those who are vaccinated seemed to...

...be getting helped from it and those who are not vaccinated are susceptible. I heard a great I don't know who was it was person on the radio, but I loved when they ask the person, well, we're hearing about people with the vaccine getting covid and and the person said yes, and I know people who have gotten the flu vaccine, who get the flu. Right words, it's never a hundred percent fool proof. That's right. But the people who have the flu shot, who have gotten the flu, have milder symptoms, have faster recovery and everything, and we're also seeing that play itself out as well with with covid but I think if you can just spend a few moments talking about what is Mrna? I think I've heard people say it alters my DNA and I know that that's not true, but maybe just again explain what, why is that? How is that technology different than like a live virus that we've used in the past, and that fact that it isn't something we just cooked up in the last eighteen months and we're throwing it out there. Yes, a great question. So, Mr and what essentially happens is the MRNA triggers the production of what's called spike protein, and that spike protein is what triggers your body to generate the antibodies to fight off covid nineteen. And then very quickly, just as soon as that spike protein is created, it's degraded and eliminated from the body, so it doesn't actually stay in the body, enter into the cells. It literally just creates that immune response and then it gets eliminated from the body. So that's what makes it very safe and very effective. And the other wonderful thing about it is it's not live, no live virus in there, so there's no risk of actually getting covid nineteen from the vaccine. So that's the technology behind it. It's the MRN a sort of comes into the body, it triggers the creation of the spike protein, which then triggers the response from the immune system. And so when I say there's other drugs coming, other drugs with very similar pathways to help the spide off things like other pathogens and even testing it in different types of cancer. Yeah, Dr Sciaguo had mentioned that he felt it was going to be potentially was going to be the the PAS to HIV, yours and prevention. So very, very exciting with stuff like that. So let's let's keep moving through some of these things that we did talk about, which I know you're ashonate about, was a term that you talked about with you which is like precision medicine, digital care, drug to patient, drone deliveries help in some of those sorts of things. Let's talk about some of that in terms of where you see pharmacology and the and and the healthcare system and and how they are continuing to evolve and expand and play an important part. Yeah, absolutely. Yeah, I mentioned one of the courses of steady as I was pursuing my doctor it was pharmaco kinetics, which essentially is the study of how drugs functioning your system. What's really exciting about precision that US know. What we know is that not everybody processes medication the same. There are a lot of genetic components that impact whether or not something is going to be effective, whether or not you're going to be more at risk for adverse events, and so what precision medicine does is it helps us have a very tailored approach based on my DNA and my genetic makeup, so that I can have the best result from a medication that I'm taking. As if we think about, you know, the way we manage patients today, as we have evidence and we know that this is the drug that can treat this condition, but we don't take in the consideration, we don't have that information necessarily about the genetic makeup of the person taking the medication, as so acision meds and allows us to do is to very specifically tailor drugs to individuals, and so it's really exciting. I think the the science has been out there for a while and there's some ways that we can we can test this things and incorporated into treatment pathways, but I think we're really on a cusp of having more information or what it really means and whether or not that drives better outcomes for patients. And so there there's some medications that you know you can just be more at risk for side effects if it's over over active in your body, and if we need that information on the front end, we could cut the things down and then you could be more successful on that medications. I see that as being a big part of how we manage patients in the future, which I think is really exciting. You think about cancer and some we use MED's all the time and cancer and hope that they're going to be effective, but oftentimes they're not. And so if we could be very specific around which cancer therapy is going to be beneficial for this patient, it's going to help patients be more successful, it's going to reduce cost of care, and they're going to be so many benefits to that. Yeah, I love that. I love that example. That's great one, because I was going to try to give an example to make sure I was understanding and your example is better than mine. But yeah, I mean I've got some friends who, unfortunately are dealing with cancer, as we all do, and you know that process of trying to find the right formula for them can be really hard right, really hard on them physically. And got a good friend and she's been dealing with just really...

...bad side effects, you know, two or three days after treatment, just white in her out for the thing and all that. And now fast forward several months they feel like, Oh, we've found the right thing and so she's taking it, it's having an effect and she's feeling good. But it sounds like what you're talking about with the precision medicine is we can eliminate those six months of pain and suffering, so to speak, and go right to the thing based upon the the the genetics and what we know the science is telling us, will work better for your your individual needs. Absolutely it's exciting. I mean it's exciting as a consumer of health care to think that some day you should I be diagnosed with cancer, that my regiment could be very tailored to what I most likely to respond to. So everybody should celebrate that that. I think that's something that's coming and we're learning a lot more about that and learning how we leave it into workflows. If we know this information up front, how do we make sure that it's in front of the prescribers at the point of care when they're making decisions around treatment? Right? Yeah, no, that's very exciting. That's very cool and in so let's talk about digital care. Is that so, if we've learned anything, because pandemic as a that we can provide a lot of care virtually. There are a lot of things that we can do to care for patients and different settings. We no longer need people to come into our four walls all the time, and so digital care is, I think, transforming the way we think about providing care to individuals inside. I see that just continuing. So we do a lot of virtual visits now. That's going to continue to happen. I think there's some digital technologies that help us more interact with people on an ongoing basis. To think about, you know, some of the things that I give an example. You've got diabetes and you know you're checking your blood share at home. Finding ways for that information to flow back to the physician and then guidance to come back to the patient is huge. We can have more real time ongoing management and empower patients to be better at a equipped to be able to manage diabetes at homes. I think digital methods of communication and interaction and care are just going to continue to grow as a part of the strategy. But also I think consumers are going to start expecting and I know I would rather if I don't need to go into the doctor's office. I'd rather be able to connect virtually and have my needs met. So I'm really excited about that. I think it also gives us opportunities to scale out services that I think are really beneficial to a lot of individuals, and so being able to connect with whether it's a nurse, you know, pharmacist, a physician, having an easy way, kind of like what we're doing today, to have a conversation is just a game change or in a difference in how we provided care in the past. Dr Bean, is your team getting involved in the telemonitoring? So you're about tele a monitoring with cardio, like you know, I might wear the vest or art monitor and my cardiologist is monitoring it or conceive the feedback. But what are you seeing in the areas of Tel a? Monitoring with medications? So two point diabetic, I've got the I've got the Monitor on and my pharmacist is sitting there saying, okay, you you know you're out, you're out of insulin and I see your spiking. You know, sort of a type of thing. Are you seeing more of that? Yeah, I think that's going to be a part of the future. There's a lot of technology that now exists to help with that flow of data, patient data, to provider, who can then provide guidance around how to Adjustos as. insulince a great example. So say you're a patient in your checking your bloodsher or your blood shore. You're on a continuous glucose monitor, so constantly checking your blood sugar. You can have a pharmacist on the other end that seeing this spikes, are seeing those trends, those patterns and making in just in time changes and insulin doses to make sure that patients stay in the range that they would like to be. So I think that's certainly a part of the future. It's remote patient monitoring and having somebody on the other end to sort of identify things before they become severe to help patients be more successful. So diabetes is a great example of that. Certainly something we're doing today with some of our pharmacists to help with Matt managing the patterns and adjusting the insulin dose to reduce the risk for the the highs and the lows that can occur with with fips are on insulin. That's great. You know, one of the things I've seen recently, and I don't know if you or your team's have seen any of this, in prototype or things like this, and I think it's kind of very relevant understanding the recent the recents Oxycotton trotten. You know settlements that are now coming out and billions of dollars being covered by the pharmacy companies who were behind it. But one of them was I saw it's an actual device that you could give to an individual that would potentially have the like. Oxycotton is a good example in it that could would limit your ability to dispense it at home. So, in other words, if it knew, if you, as the pharmacist would put in a month supply or thirty, let's say, thirty tablets of boxy cotton and you could set it to say this is only to distribute one per day, personal, let's say, and then this is the person could take the system through a...

...thumb print or something verified that they were who they were and it would drop out the one tablet. They could take it, but if it got tampered with or broken open, the pharmacy or somebody would be notified that, you know, something has been breached. Have you seen anything like that and do you think that's going to take hold here? Yeah, I mean, I haven't personally seen that, but it wouldn't surprise me and it sounds very familiar to some of the things in evenious that we do in the hospital. So we have patient controlled and Analgesia where you may have, and I'd be going a pain medication and then set, you know, to provide a certain amount over a certain period of time and then if you need a bull of sto so you can, you can get a bullists, but their limits and we're able to set the guard rails around that to make sure that we keep our patient safe. So I love the example that you're sharing, because certainly it's a way to keep patient safe in the in the out patient setting. If we had a mechanism to make sure only what they need to be getting and should be getting is what they're actually getting, not only is it going to make sure they're not overdocing or getting too much, but make sure that they're not vulnerable to other people are trying to access and gain access as medications. So I do think, you know, lots of technology out there to help keep patients safe and also provide better care for patients, and I think our job now is to think about what are the problems that we're trying to solve and what technology exists to help us solve those problems, because there's no shortage of technology and innovation happening out there. But finding the tools that are going to be the most meaningful and the most impactful it's part of the work as well, and making sure that we're thoughtful and how we met those things out to make sure that it's going to meet the needs of our consumers. Yeah, the place I heard that mechanisms having a lot of success and it makes sense and where they're testing it is in clinical trials. Yeah, because what they're loving is it's also giving the data back to the clinical trial that shows that the patient who is taking the medication followed the routine, because the said, because that little container that's dispensing the tablet is feeding the data to say they didn't take it too much, they didn't take it too little, they took it exactly right, you know, all that sort of stuff. And and I think and it's a great place for to be trying that mechanism to see how it works well. And what I love about the example you shared, an Alberadin at beyond just, you know, oxycotton and the OPIOU set thedemic and trying to minimize risk assisition with that. We haven't it that we have an adherence problem. So, yeah, it's not uncommon for people not even to fill the prescription, much less, you know, take the medication on an ongoing basis the way it was intended. And so tools like that will help help people be more successful with maintaining therapy so that they can achieve the desired outcome. And said, I love, you know, the technology and innovation that's happening around better identifying, you know, what are the barriers to adherence. Is it a knowledge barrier? Is it an affordability issue? Is a side effects that just never get reported back to the physician who can make an intervention? So I love the idea of getting smarter about identifying the adherence barriers, WHO's at risk for adherence issues and more proactively tailoring interventions to help people be successful in medications. And let's say nobody wants to take medication, but there are life saving medications out there, life changing quality of life changing medications out there that if we're able to help people feel a little more comfortable, help people be a little bit safer and make scary medications a little bit more exciting around what the what the actual outcome can be if you're able to be consistent with taking it. Think about the difference we would make in a lot of lives if we could, we could overcome some of those challenges to actually taking medication that's prescribed for a condition. Absolutely, absolutely well. So, as we're as we're coming up on some time here, I just wanted to I know one of the thing I wanted to mention to you, which I know you're passionate about, and really it's really important to you is health equity. We talked about that and I'd love for you to share with our listeners a little bit more about you're feeling. You know, what's going on with there and and why is that? Why is that a passion for you and for Navan? Yeah, I mean I think for me, just a recognition that not everybody has the same access to healthcare. There are there are healthcare deserts in the communities that we live in where there's literally not a pharmacy and they're not healthcare facilities for individuals. And so how do we make sure that we have equable access to care? And so what can happen sometimes when you look at I'll give the adherence and as an example, if you look at an adherence metric and you look at a percentage of individuals that are taking a medication as prescribed, if you don't look at it with the Lens of, you know, age and race and ethnicity and things like that, sometimes you can mess out on some of those challenges that can be unique to certain groups. And so what we try to do is start thinking about looking at things like adherents with sort of sort of those dimensions of diversity to understand where there may be some unique means that we might need to tailor our approach to helping people be successful in medication differently, and so that's why it's a...

...passion of mine, because I think what we're recognizing is we don't have equitable care today. We have people that don't have access and it's our responsibility as healthcare providers to be able to bring bring access and care to the individuals who need it the most. And so if we don't look specifically at those different dimensions and diversity and understand where the the gaps are, we're not going to be successful with improving health and delivering on our missions. It's super important for us to be able to understand what that looks like. So I I had told my team, you, let's really think differently and challenge biases around and how we're doing today and where we need to be position to be able to provide unique solutions for folks so that everybody can be successful on the medications that they're taking. Sure well, I'm sure like any state, I mean you know North Carolina and in the southeast area that you guys service. You know. I'm sure you know you getting access in Charlotte and Raley, you know, is that's not necessary an issue. But when you get into the more rural communities, they're struggling to get physicians in those in those markets. I'm sure access to medication and what's needed, and that is no different. is No different. It's not mutually exclusive. Exactly when, and you mentioned during delivery, and we're looking at innovation and how we actually get medication to consumer, and so there's a lot of work happening and what we call last mile delivery, and so it's just super exciting to think about a day where maybe your medication comes directly to your doorstep and it's coming to you by drone, you know, on your phone. Okay, my medications coming, here's what time it's going to come. I mean how convenient is that if you have a virtual visit with a physician and they prescribe a medication and one hour later it's delivered to your door? I mean, that's exciting to think about and there's a lot of innovation happening there around how we actually get medication to consumer, because I think that our consumers are going to demand it and the technology is going to be there to support it. Yeah, very exciting, you know, and if you know, not just in and in pharmacy, but obviously in the all lines of medication, and I mean numage issues, me health care. It's just amazing. I mean more and more with the with the with the show. I want to start, you know, focusing on some of these really leading edge technology things that are coming. I know again we talked about this Dr Ascaglu and he's such a champion of all that and being a former aerospace he's a little bit of the Geek in behind him that he loves. But it's fun, it's fun to talk about and to think about where we can go. Dr Bean, has been a pleasure having you on. We always kind of close the episodes with my favorite question, which is who's your hero? So, as we start to wrap things up and you think about it, who was your hero now or growing up, or any at any time in your life? You know, I will say my hero now probably is different than what I've have said as I was growing up, but, and I'm not going to pick this one, I'm going to say my parents, my mother or my father, or my heroes. I mean my dad literally save my life. It's a story I must felt out of waterfall and you Semite National Park and he caught me before actually fell. So he literally saved my life. But I say my parents because they just invested in me so that I could be successful. I mean, I think about my attitude towards life, you know, being grateful for what you have, giving back, having an emotional intelligence, and how I interact with people and how I approach problems and how I work through adversity, all of that I learned from my parents and I that's what makes me successful is being a well to deal with adversity and put a positive spin on it and be grateful for what I have and be grateful for the the opportunities that I have given. So they're might here. Is because I wouldn't be who I am if not for my team parents. Well, I think for a lot of us that's the case and I think you know, obviously you appreciate and I feel lucky to have that same situation with my father and my mother was as well, but not I think for a lot of us that that's where it resides and I think as we get as we get older, we become more appreciative of them and who they are and what they did for us. So I love that and I love your heart. I Love Your Passion for what you do. We appreciate all the work that you do, you and your team had Nivan. So thank you very much. Thanks for being part of the show and I'm sure we would love to all as I always I always want to keep a little open door. We'd love to come back and, as things continue to evolve and grow, have you back on the show in the future and give it give everybody an update as to what's new in the world of pharmacy and healthcare. I would love that. Said, thank you for the opportunity. I have just really enjoyed the opportunity for a chat this morning and would be glad to come back in the future. Great, well, thanks again. We're being part of the PODCAST. Absolutely you've been listening to heroes of healthcare. For more, subscribe to the show in your favorite podcast player or visit us at heroes of healthcare podcastcom.

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